How to use it
Score five segments: ileum, right colon, transverse colon, left colon (sigmoid and descending) and rectum. In each, score four variables from 0 to 3: size of ulcers, ulcerated surface, affected surface and narrowing. The SES-CD is the sum, from 0 to 60 (in practice 0–56, since a narrowing that cannot be passed stops you reaching the segments beyond it).
For each segment, pick one:
- Normal: you saw it and all four variables are 0.
- Findings: score each variable. The segment subtotal updates as you go, and you can hide a finished segment.
- Not reached: left out of the total. The result is then labelled partial, with the missing segments named.
Reading the result
| SES-CD | Usual label |
|---|---|
| 0–2 | Inactive |
| 3–6 | Mild |
| 7–15 | Moderate |
| 16 or more | Severe |
These bands are the convention most trials have used; they came after the original validation and some studies draw the line between moderate and severe slightly differently (Koutroumpakis 2016).
STRIDE-II targets for Crohn’s disease:
- Endoscopic healing (long-term target): SES-CD below 3, or no ulcers anywhere (every ulcer-size subscore 0).
- Endoscopic response: a fall of more than 50% from baseline. Enter the baseline score to check it.
Partial examinations
The original score has no way to record a segment you did not see, so it quietly treats it as normal. Here an unexamined segment is excluded instead. A partial score can still be useful, but:
- It may underestimate activity, especially if the ileum wasn’t intubated.
- Compare it only with a score from the same segments. A response calculated against a full baseline can look better than it is.
- Say in the report which segments were not reached and why (for example, a narrowing that couldn’t be passed, or poor preparation).
Pitfalls
- Ulcer size and ulcerated surface go together. If there are no ulcers, both are 0. The tool flags a mismatch.
- Affected surface counts any lesion, not just ulcers, so it can be higher than the ulcerated surface.
- Isolated ileal disease has a low ceiling (at most 12 from one segment), so modest totals can still mean significant disease. Consider transmural assessment with intestinal ultrasound or MR enterography.
- Postoperative recurrence at the anastomosis is graded with the Rutgeerts score, not the SES-CD.